Vaginal foreign body removal (Child) Facilitator: Pawin Puapornpong

Vaginal foreign body removal (Child)  Ref : Textbook of Pediatric Emergency Procedures, 2 nd Ed  Ref : The Johns Hopkins Manual of Gynecology and Obstetrics  Ref : Textbook of Pediatric Emergency Procedures, 2 nd Ed  Ref : The Johns Hopkins Manual of Gynecology and Obstetrics

Vaginal foreign body removal (Child)  Most common at ages 2 to 4  Toilet paper, buttons, coins, peanuts, crayons  Present with bloody, brown, purulent discharge  Genital pruritus, abdominal pain, fever  Peritonitis can be develop from ascend of purulent  Most common at ages 2 to 4  Toilet paper, buttons, coins, peanuts, crayons  Present with bloody, brown, purulent discharge  Genital pruritus, abdominal pain, fever  Peritonitis can be develop from ascend of purulent

Vaginal foreign body removal (Child) Indication - ประวัติวัตถุแปลกปลอมในช่องคลอด - ผู้ป่วยมีอาการผิดปกติในช่องคลอดซึ่ง จำเป็นต้องหาสาเหตุที่เกิดจาก วัตถุแปลกปลอม Contraindication - ผู้ป่วยไม่พร้อม หรือไม่ยินยอมทำหัตถการ

Vaginal foreign body removal (Child) เครื่องมือ - 8 French feeding tube - 60-mL syringe - Warmed normal saline or sterile water - Viscous lidocaine - Cotton or Dacron swabs - Emesis basin (optional) - Absorbent underpads - Light source

Vaginal foreign body removal (Child) เตรียมผู้รับการตรวจ In prepubertal child, Irrigation may be sufficient. If unsuccessful, removal under GA may be required. In toddler or young girl exam under anesthesia. ATB before removal.

1. Explain the procedure to the child. 2. Set up the equipment, fill a 60-cc syringe with saline and firmly attach to an 8 French feeding tube; prime the feeding tube with saline. 3. Visualize the hymenal orifice using labial traction; allow the child to relax before inserting the feeding tube. 4. Apply viscous lidocaine to the hymen with a cotton swab if necessary. 5. Gently pass the distal end of the catheter through the hymenal orifice into the vagina until slight resistance is felt. 6. Tell the child she may feel cold water 7. Irrigate the vagina until the effluent is clear. 8. Ask the child to cough during the irrigation to help expel small pieces of toilet tissue. 9. Hold the labia downward toward the buttocks to help the foreign body exit.

Vaginal foreign body removal (Child) ภาวะแทรกซ้อนที่อาจ เกิดขึ้น Inserting the feeding tube should not injure the tissues in any way. Forceful restraint and irrigation of the vagina in an uncooperative child poses a risk of traumatic injury In such situations, examination under anesthesia is the safer The most common problem is failure to successfully remove a foreign body that is lodged in the proximal vagina.

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